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Pain Management

According to the American Society of Interventional Pain Physicians (ASIPP), interventional pain management is a "discipline of medicine devoted to the diagnosis and treatment of pain related disorders." Interventional pain medicine utilizes a multidisciplinary approach, in which a team of health care professionals works together, to provide a full range of treatments and services for patients suffering from chronic and/or acute pain.

The goals of interventional pain management are to relieve, reduce, or manage pain and improve a patient's overall quality of life through minimally invasive techniques specifically designed to diagnose and treat painful conditions. Interventional pain management also strives to help patients return to their everyday activities quickly and without heavy reliance on medications.

Back Pain and Interventional Pain Management Treatments
For back pain sufferers, interventional pain management techniques can be particularly useful. In addition to a thorough medical history and physical examination, interventional pain management physicians have a wide array of treatments that can be used including the following:

Epidural injections (in all areas of the spine)
 The use of anesthetic and steroid medications injected into the epidural space to relieve pain or diagnose a specific condition.

Nerve Root and Medial Branch Blocks
Injections done to determine if a specific spinal nerve root is the source of pain. Blocks also can be used to reduce inflammation and pain.

Facet Joint Injections
An injection used to determine if the facet joints are the source of pain. These injections can also provide pain relief.

Discography
An "inside" look into the discs to determine if they are the source of a patient's pain. This procedure involves the use of a dye that is injected into a disc and then examined using x-ray or CT scan.

Pulsed Radiofrequency Neurotomy (PRFN)
A minimally invasive procedure that disables spinal nerves and prevents them from transmitting pain signals to the brain.

Rhizotomy
A procedure in which pain signals are "turned off" through the use of heated electrodes that are applied to specific nerves that carry pain signals to the brain.

Spinal Cord Stimulation
The use of electrical impulses that are used to block pain from being perceived in the brain.
 
Intrathecal Pumps
A surgically implanted pump that delivers pain medications to the precise location in the spine where the pain is located.

Percutaneous Discectomy/Nucleoplasty
A procedure in which tissue is removed from the disc in order to decompress and relieve pressure.

Interventional pain management physicians often include other treatments such as physical therapy, occupational therapy, and lifestyle modification (such as exercise, diet, and smoking cessation) to further enhance these procedures.

FAQ
I am having an epidural steroid injection for my low back pain. I am just wondering—does the injection hurt, and will it actually reduce my pain? Will I need to have multiple injections?
The answer is both yes and no. If you have an injection into an area that's already inflamed, you may have pain because that area is more sensitive. However, before getting an injection, you'll most likely have an anesthetic such as Lidocaine. The anesthetic will numb the area where you're going to have the steroid injection.

Depending on what's causing your low back pain, the epidural steroid injection should work. For example, it's been shown that injections work very well for herniated discs. An epidural steroid injection helps to reduce the inflammation and therefore, the pain.

 If it's spinal stenosis causing your low back pain, an epidural steroid injection might not be as helpful in reducing your pain. I've noticed that patients with bony spinal stenosis. Patients with pain caused by a degenerative or arthritic spine condition can still have injections, but they need to be aware that it might not be as helpful as they wish.

Now for your final question: Will I need to have multiple epidural steroid injections?

I have found that patients do generally require more than one injection, so I generally administer a short series. Your doctor will decide how many injections are best for you, and he will carefully monitor how your pain responds to the injection.

I would like to add that the goal of an epidural steroid injection isn't to completely obliterate your pain. In fact, injections should be used in conjunction with a physical therapy exercise program. The injection will take care of the pain and inflammation so that you're able to participate in the active exercise portion of your recovery. You will probably have an exercise program that increases your muscle flexibility and strength, in addition to helping you get back to functioning normally.

Are Epidural Steroids Useful?
The answer: It depends on whom you ask. The controlled studies are split. Two major problems complicate the story. The first is that many different diagnoses may cause the pain, and epidural injections may work for some of these diagnoses better than others. The second problem is that the success of the injection may depend on the technique that is used.

The traditional epidural injection technique involves the doctor feeling the patient’s spine in order to guide the placement of a needle between the spinal vertebrae. A newer technique involves using x-ray fluoroscopy to guide the needle directly to the neural foramen, the point where the affected spinal nerve root exits the spine. This is likely to increase the success of the procedure.

For patients with nerve root pain involving one or two roots, I believe that fluoroscopically guided foraminal injections will prove to be superior to the approaches that do not use x-ray guidance. Epidurals in general, but especially foraminal injections, do not appear to be as effective if the pain is caused by widespread degenerative or arthritic problems in the spine.

Do epidural steroid injections work? Yes, if the problem is back and leg pain triggered lumbar disc herniations, and if fluoroscopy is used to guide the injection directly to the affected nerve roots.

Do epidural injections work for other causes of back pain? Good data is not available. In my experience, the injections can often help, but with other diagnoses the rate of success is not as great.

* " The information contained here is not intended as a substitute for professional medical evaluation and management. It should be used only as a starting point for further research. A physician should always be consulted for any health problem. "

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